How to Appeal a Anthem Blue Cross Blue Shield Ambulance Services: Ground; Emergent Denial

What Anthem Blue Cross Blue Shield requires for coverage

Anthem Blue Cross Blue Shield considers Ambulance Services: Ground; Emergent medically necessary when the following criteria (from CG-ANC-05) are met:

• Ambulance is equipped with necessary equipment and supplies for individual's needs
• Individual's condition requires ambulance transport (other transport methods are medically contraindicated)
• One of the following circumstances applies: (A) Transportation from the scene of a life-threatening accident or emergency to the nearest hospital or physician's office with appropriate facilities, OR (B) Transportation to or from one hospital or medical facility to another hospital or medical facility, skilled nursing facility, or free-standing dialysis center in order to obtain emergent medically necessary diagnostic or therapeutic services
• Mileage coverage is provided up to the distance required for transport to the nearest appropriate facility
• Deceased individuals covered when: (A) Person pronounced dead en route or upon hospital arrival, OR (B) Person pronounced dead by authorized individual after ambulance dispatch but before pickup

Covered procedure codes

A0225	Neonatal transport, base rate, emergency, one way
A0380	BLS mileage (per mile)
A0390	ALS mileage (per mile)
A0425	Ground mileage, per statute mile
A0427	Advanced life support, Level 1 emergency
A0429	Basic life support emergency transport
A0432	Paramedic intercept, rural area
A0433	Advanced life support, Level 2
A0434	Specialty care transport
A0998	Ambulance response and treatment, no transport

How to appeal this denial

Frame your appeal around the specific criterion you satisfy. Quote the CG-ANC-05 language above, then show — with your physician's records and clinical evidence — exactly how your situation meets it. Demand that Anthem Blue Cross Blue Shield either approve the claim or identify the precise criterion they believe you fail. CareCost Appeals assembles this automatically: it cites the policy, pulls verified clinical evidence, and applies your state and federal appeal rights.

Source: Anthem Blue Cross Blue Shield medical policy CG-ANC-05 — view the published policy.